Division of Infectious Disease, Department of Internal Medicine, Chi Mei Medical Center-Liouying, Tainan, Taiwan.
Department of Medical research, Chi-Mei Medical Center, Tainan, Taiwan.
Sci Rep. 2017 Jul 26;7(1):6634. doi: 10.1038/s41598-017-06878-6.
Klebsiella pneumoniae (KP) resistance to broad-spectrum cephalosporin (BSC) in meningitis is important because of limited therapeutic options. To investigate the antibiotic resistance, virulence and epidemiology of KP in meningitis, we conducted a retrospective study for 33 non-metastatic isolates, including primary meningitis (n = 20) and post-craniotomy meningitis (n = 13) collected from 1999 to 2013. BSC resistance was found in 9 (27.3%) isolates, all from post-craniotomy meningitis, harboring bla (n = 6), bla (n = 2), bla (n = 2), and bla (n = 1). Positive virulence factors were hypermucoviscosity (n = 22), larger bacterial size (n = 24), virulent capsule serotypes (n = 24, K2, 11; K1, 5; K57, 3; K5, 2; K20, 2 and K54, 1), rmpA (n = 23), rmpA (n = 20), aerobactin gene (n = 22) and high-grade serum resistance (n = 23, 69.7%). Higher mouse lethality (LD < 10) was found in 16 isolates (48.5%). Post-craniotomy isolates were significantly less virulent than primary meningitis isolates, except for similar serum resistance capability. The pulsotype and sequence typing (ST) results were diverse. A minor cluster with pulsotype C and ST23 (n = 5) was identified in primary meningitis isolates. In conclusion, virulence factors and BSC resistance corresponded to about 70% and 30% of KP meningitis isolates respectively. BSC remains appropriate for treating primary meningitis, whereas meropenem is indicated for post-craniotomy meningitis empirically.
肺炎克雷伯菌（KP）对广谱头孢菌素（BSC）的耐药性在脑膜炎中很重要，因为治疗选择有限。为了研究脑膜炎中 KP 的抗生素耐药性、毒力和流行病学，我们对 1999 年至 2013 年间收集的 33 例非转移性分离株（包括原发性脑膜炎（n=20）和开颅术后脑膜炎（n=13））进行了回顾性研究。发现 9 株（27.3%）分离株对 BSC 耐药，均来自开颅术后脑膜炎，携带 bla（n=6）、bla（n=2）、bla（n=2）和 bla（n=1）。阳性毒力因子为高粘液性（n=22）、较大的细菌大小（n=24）、毒力荚膜血清型（n=24，K2、11；K1、5；K57、3；K5、2；K20、2 和 K54、1）、rmpA（n=23）、rmpA（n=20）、aerobactin 基因（n=22）和高血清耐药性（n=23，69.7%）。16 株（48.5%）小鼠致死率（LD<10）较高。开颅术后分离株的毒力明显低于原发性脑膜炎分离株，除血清耐药能力相似外。脉冲型和序列分型（ST）结果多种多样。在原发性脑膜炎分离株中发现了一个带有脉冲型 C 和 ST23 的小集群（n=5）。结论，毒力因子和 BSC 耐药性分别约占 KP 脑膜炎分离株的 70%和 30%。BSC 仍适用于治疗原发性脑膜炎，而美罗培南则适用于经验性开颅术后脑膜炎。
